title: A rare complication of a unilateral vertebral artery occlusion, which resulted in a basilar emboli after a C5-C6 bifacet dislocation in a professional rugby player: case study.
abstract: BACKGROUND
  Vertebral artery damage after cervical fracture and especially cervical dislocations is a recognized phenomenon. The incidence of significant intracranial neurology after unilateral vertebral damage is extremely rare, and to our knowledge, no such injury has been sustained while playing sport.
  
  
  OBJECTIVE
  To describe a rare vascular complication of a bifacet C5-C6 dislocation.
  
  
  METHODS
  Case report and clinical discussion.
  
  
  METHODS
  We present a 28-year old white man who was a professional rugby player. He sustained a hyperflexion injury while playing scrum half in a recent league match, which resulted in a C5-C6 dislocation, diagnosed clinically and with a plain radiograph. The patient on admission had complete neurologic loss below C6.
  
  
  RESULTS
  The patient underwent immediate computed tomography and magnetic resonance imaging (MRI) scans that revealed a 50% displacement of C5 on C6 with a complete unifacet dislocation and the other facet partially dislocated. The MRI revealed signal changes in the cord at the C5-C6 level and an intimal tear in the left vertebral artery. The decision was taken to reduce the dislocation when medically stable. A few hours after injury, after an episode of vomiting, the patient sustained a respiratory arrest owing to the embolization of a clot from the left vertebral artery into the basilar artery. Despite rapid embolectomy and subsequent permanent left vertebral artery occlusion, the patient sustained multiple infarcts in the cerebellar, thalamic, occipital, and pontine regions of the brain that eventually proved fatal.
  
  
  CONCLUSIONS
  This case shows a rare complication of unilateral vertebral artery occlusion. Despite early identification of a basilar infarct and a successful embolectomy, intracranial infarction occurred. Although there is no guideline for the treatment of vertebral artery damage, early reduction and anticoagulation may reduce the risk of cerebral infarction.
authors.affiliation: Department of Trauma and Orthopaedics, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, United Kingdom. simondavies@doctors.org.uk
authors.forename: Simon R
authors.initials: SR
authors.lastname: Davies
mesh_terms: D000328:Adult; D001157:Arterial Occlusive Diseases / Q000150:complications* / Q000473:pathology; D001265:Athletic Injuries / Q000150:complications* / Q000473:pathology / Q000601:surgery; D001488:Basilar Artery / Q000473:pathology; D020520:Brain Infarction / Q000209:etiology / Q000473:pathology; D002574:Cervical Vertebrae / Q000293:injuries* / Q000473:pathology; D004617:Embolism / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D017809:Fatal Outcome; D006801:Humans; D004204:Joint Dislocations / Q000150:complications* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D014057:Tomography, X-Ray Computed; D014711:Vertebral Artery / Q000293:injuries* / Q000473:pathology; D014715:Vertebrobasilar Insufficiency / Q000209:etiology / Q000473:pathology